Information on this page is arranged in three broad groups:
Please read our suggestions for sensible use of this information
Professional Clinical Practice Guidelines & Policy Statements
Confusing Terms in Medicine: Standard
and Standards
The term standard
is a source of confusion for many consumers. The meaning depends largely on whether standard
is used as a noun or an adjective. (Remind me of the definitions) The following may help avoid unnecessary confusion.
1. Standard
is frequently used as an adjective to contrast medical treatment with the experimental intervention in research. Standard care
or standard treatment
are often used as descriptive terms to distinguish between an established medical treatment and an experimental intervention in research. For example, a clinical trial might compare an experimental drug with an established medical treatment in patients diagnosed with a specific disorder.
2. Standard
can be used as an adjective to rank available treatments for a medical condition. There are often several treatments for a medical condition and sometimes standard treatment
is used (slightly inaccurately) to refer to the most appropriate or best available treatment. Determining which treatment works best for a given medical condition is not the same thing as determining the best treatment for an individual patient in a specific situation. Evidence-based medicine tries to inform physician treatment decisions in medical practice with data from published research. In many cases published data is inadequate to determine which of two (or more) treatments is most effective. Even when research exists to show that one treatment is more effective than others, the most effective treatment may not necessarily be the best treatment for every patient in every situation. To take the obvious example, the most effective drug is not the best treatment if the patient is allergic to it. Selecting the best treatment from a range of available treatments depends upon professional medical evaluation of the individual patient. Clinical practice guidelines published by professional organizations are intended to guide physicians in evaluation and selection of treatment for an individual patient. Clinical practice guidelines don't specify a standard per se because they don't dictate what treatment is best; rather clinical practice guidelines outline the professionally recognized process for selecting the best treatment for an individual. On a related note, there are some medical conditions for which curative treatment currently doesn't exist. In this situation some might say there is no standard treatment. This is inaccurate because standard treatment actually consists of palliative and symptomatic treatment. While there may be no cure it's virtually never the case that the professional standard of medical care is to do nothing.
3. Standard
can be used as a noun or adjective to identify a single widely accepted treatment for a medical condition. Standard of care
or standard treatment
can refer to a widely accepted professional agreement about the treatment of a specific medical condition.
4. Standard
is often used as a noun in evaluating the professional conduct and judgment of an individual physician in a specific situation. The Standard of Care
has a special meaning in civil law (e.g., in medical malpractice cases):
A physician must possess that reasonable degree of learning, skill and experience which is ordinarily possessed by others in his profession. … In the care and treatment of each patient, each physician has a non-delegable duty to render professional services consistent with that objectively ascertained minimally acceptable level of competence he may be expected to apply given the qualifications and level of expertise he holds himself out as possessing and given the circumstances of the particular case.
Hall v. Hilbun, 466 S. 2d 856, 869, 870 (Miss. 1985).
Government :: U.S.
Government :: International
Independent Organizations, Quality of Care
Medical Lab Tests
GAO-06-977T Nutrigenetic Testing: Tests Purchased from Four Web Sites Mislead Consumers. General Accountability Office Report. 2006-07-27. Accessed on 2006-08-01 at: http://www.gao.gov/new.items/d06977t.pdf
(Heavy metal testing) McKay CA, Holland MG, Nelson LS. A Call To Arms For Medical Toxicologists: The Dose, Not The Detection, Makes The Poison. Int J Med Toxicol. 2003;6(1):1. Accessed on 2006-07-01 at: http://www.ijmt.net/ijmt/6_1/6_1_1.htm
Vaccines
Reference Books
Gray H. Anatomy of the Human Body. Philadelphia: LEA & Febiger, 1918. New York: Bartelby.com, 2000. Accessed on 2007-05-13 at: http://www.bartleby.com/107/
Beers MH, Berkow R, editors. The Merck Manual of Diagnosis and Therapy (Seventeenth Edition). 1999-2005 Merck & Co., Inc., Whitehouse Station, NJ, USA. Accessed on 2007-05-13 at: http://www.merck.com/pubs/mmanual/
Beers MH, editor. The Merck Manual of Medical Information — Second Home Edition, Online Version. 2004-2005 Merck & Co., Inc., Whitehouse Station, NJ, USA. Accessed on 2007-05-13 at: http://www.merck.com/mrkshared/mmanual_home2/home.jsp
Evidence-Based Medicine (EBM)
Booth A. (Compiler) What percentage of practice is evidence based? Resource Guide. September 19, 2000. School of Health and Related Research (ScHARR) web site, University of Sheffield. Accessed on 2005-12-15 at: http://www.shef.ac.uk/scharr/ir/percent.html
Web Resources. Information Resources Section, School of Health and Related Research (ScHARR) web site, University of Sheffield. June 7, 2005. Accessed on 2005-12-15 at: http://www.shef.ac.uk/scharr/sections/ir/links
The Board of Regents of the American College of Dentists. The Ethics of Quackery and Fraud in Dentistry: A Position Paper. Excerpted from the Journal of the American College of Dentists. 2003:70(3):6-8. Accessed on 2006-07-01 at: http://www.facd.org/acdethics4.htm
State Resources
Information about physician and dentist licensing, professional training and education, and discipline is available from state medical, osteopathic, and dental boards. Follow this link to CIRCARE's Complete List of State Medical and Osteopathic Licensing Boards Online. Try state web sites to locate dental boards.
If you aren't sure where a physician is licensed, you may be able to find this information in the Unique Physician Identification Number (UPIN) Registry
The AIM DocFinder lets people search for a physician in many (but not all) states simultaneously: Administrators in Medicine (AIM) DocFinder
The Federation of State Medical Boards (FSMB) provides physician disciplinary reports for a fee: http://www.docinfo.org/
Other useful resources from FSMB include:
Special Committee on Questionable and Deceptive Health Care Practices. Federation of State Medical Boards. 1997-04. Available from http://www.fsmb.org/pdf/1997_grpol_Deceptive_Health_Care_Practices.pdf
Policy Documents Index. Federation of State Medical Boards. Available from http://www.fsmb.org/grpol_policydocs.html
U.S. Government Healthcare Provider Information
Patient-Based Rating Web Sites
Take information from these web sites for what it is: opinion.
Medical Testing Laboratories
Locate medical testing laboratories accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) with the JCAHO Quality Check Advanced Search: Search by Type of Provider and Service: http://www.qualitycheck.org/SearchProByType.aspx
Centers for Medicare and Medicaid Clinical Laboratory Improvement Amendments (CLIA) Overview: http://www.cms.hhs.gov/clia/01_overview.asp
Centers for Medicare and Medicaid registries of medical testing labs sanctioned by the federal government under the Clinical Laboratory Improvement Amendments (CLIA):
2008 CPT–4 and HCPCS Codes Subject to CLIA Edits
What might this information mean to you? All things being equal, when you have the choice, select a medical testing lab that hasn't been sanctioned.
The information on this web page has strengths and limitations that you should keep in mind. We've attempted to provide accurate reliable information prepared by government agencies and recognized professional organizations that's informative and useful for patients and consumers. Any comments on utility, size of collection, or accessibility reflect our nonprofessional opinion based on experience in use.
This information is not medical advice. CIRCARE officers and board members do not offer medical advice. Those CIRCARE officers or board members licensed to practice medicine are not offering you medical advice here. We firmly believe that medical decisions should be made by you and your primary care physician.
Don't make medical decisions based upon what you read here or anywhere else on the internet.
Don't stop, start, or change medicines or medical treatment without consulting a licensed physician.
Notes
1. Noun: a person, place, or thing. Example: dog. Adjective: a word that describes (or modifies) a noun. Example: brown dog.
Last Updated: 2008-03-26
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